Use of FibroScan-AST (FAST) Score and Fibrosis-4 Index to Identify Advanced Liver Fibrosis in Patients with Type 2 Diabetes and Metabolic Dysfunction-Associated Steatotic Liver Disease

Q: What was the main goal of this study?

To compare the diagnostic performance of the FibroScan-AST (FAST) score versus the Fibrosis-4 (FIB-4) index for identifying advanced liver fibrosis in Saudi patients with type 2 diabetes and MASLD.

Q: How did the study identify advanced fibrosis?

All patients underwent vibration-controlled transient elastography (VCTE). Liver stiffness measurement (LSM) was used as a surrogate marker for liver biopsy to identify advanced fibrosis.

Q: Which model performed better for detecting advanced fibrosis?

The FAST score showed better diagnostic performance than the FIB-4 index, including higher accuracy, sensitivity, negative predictive value, and a higher AUROC.

Sep 30, 2026

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Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in type 2 diabetes (T2D), and advanced fibrosis strongly predicts liver morbidity and mortality, making early noninvasive risk stratification essential. This retrospective study compared FibroScan-AST (FAST) and Fibrosis-4 (FIB-4) for identifying advanced fibrosis in 273 Saudi patients with T2D and MASLD using VCTE, with liver stiffness measurement as a biopsy surrogate. FAST outperformed FIB-4 for advanced fibrosis detection, with higher accuracy, sensitivity, negative predictive value, and AUROC.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Introduction

Methods

Results

Conclusions

Article Use of FibroScan-AST (FAST) Score and Fibrosis-4 Index to Identify Advanced Liver Fibrosis in Patients with Type 2 Diabetes and Metabolic Dysfunction-Associated Steatotic Liver Disease Abir Alsaid 1,2, Reem J. Al Argan 2,3, Yasir A. Elamin 2,3, Nora Alshiekh 4, Amna Hassan 4, Abdullah Alotaibi 2,4, Ihab Gaarour 5 and Mona H. Ismail 2,4, * Academic Editor: Kei Moriya Received: 23 November 2025 Revised: 12 December 2025 Accepted: 19 December 2025 Published: 21 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Division of Pulmonary, Department of Internal Medicine, King Fahd Hospital of the University, Al Khobar 31952, Saudi Arabia; [ahsaid@iau.edu.sa](ahsaid@iau.edu.sa) 2 College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; [rjalarqan@iau.edu.sa](rjalarqan@iau.edu.sa) (R.J.A.A.); [yaelamin@iau.edu.sa](yaelamin@iau.edu.sa) (Y.A.E.); [adotaibi@iau.edu.sa](adotaibi@iau.edu.sa) (A.A.) 3 Division of Endocrine, Department of Internal Medicine, King Fahd Hospital of the University, Al Khobar 31952, Saudi Arabia 4 Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, Al Khobar 31952, Saudi Arabia; [noorahaad2018@gmail.com](noorahaad2018@gmail.com) (N.A.); [aohassan@iau.edu.sa](aohassan@iau.edu.sa) (A.H.) 5 Department of Anesthesia, King Fahd Hospital of the University, Al Khobar 31952, Saudi Arabia; [drg3ror@yahoo.com](drg3ror@yahoo.com) * [Correspondence: mismail.md@gmail.com](Correspondence: mismail.md@gmail.com) Abstract Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in patients with type 2 diabetes (T2D), and advanced fibrosis is the strongest predictor of liver-related morbidity and mortality. Therefore, early noninvasive risk stratification is critical. While the Fibrosis-4 (FIB-4) index and vibration-controlled transient elastography (VCTE) are widely used, the newer FibroScan-AST (FAST) score has shown promise in detecting at-risk metabolic-associated steatohepatitis (MASH) with significant fibrosis. Evidence comparing the FAST and FIB-4 indices in Middle Eastern T2D populations remains limited. We compared the diagnostic performances of these models for advanced fibrosis in Saudi patients with T2D and MASLD. Methods: We conducted a retrospective analysis of 273 patients diagnosed with T2D and MASLD. All patients underwent VCTE. To identify advanced fibrosis, we used liver stiffness measurement (LSM) as a surrogate marker for liver biopsy. We calculated the FAST and FIB-4 indices for each patient. To assess the diagnostic performance of these scores, we evaluated their sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUROC) . Results: In this cohort study, 26.4% of participants had a high-risk FAST score (>0.35; median: 0.13) . Patients with high-risk FAST scores (>0.35) were younger, had higher BMIs, elevated liver enzyme levels, and poorer glycemic control than those in the lower-risk groups. High-risk FAST scores were strongly correlated with elevated LSM, FIB-4, and controlled attenuation parameter values (p < 0.001) . The FAST score demonstrated better performance than the FIB-4 index in detecting advanced fibrosis. It showed higher accuracy (85.4% vs. 77.3%), sensitivity (82.0% vs. 48.0%), and negative predictive value (95.5% vs. 87.8%) while maintaining a similar specificity. The AUROC values were 0.936 (95% CI: 0.901–0.971) for the FAST score compared to 0.711 (95% CI: 0.625–0.797) for the FIB-4 index. Conclusions: The FAST score demonstrated better diagnostic accuracy than the FIB-4 index and identified patients with poor metabolic control and obesity as being at the highest risk among Saudi pa

FAQs

What was the main goal of this study?

To compare the diagnostic performance of the FibroScan-AST (FAST) score versus the Fibrosis-4 (FIB-4) index for identifying advanced liver fibrosis in Saudi patients with type 2 diabetes and MASLD.

How did the study identify advanced fibrosis?

All patients underwent vibration-controlled transient elastography (VCTE). Liver stiffness measurement (LSM) was used as a surrogate marker for liver biopsy to identify advanced fibrosis.

Which model performed better for detecting advanced fibrosis?

The FAST score showed better diagnostic performance than the FIB-4 index, including higher accuracy, sensitivity, negative predictive value, and a higher AUROC.

What patient characteristics were associated with high-risk FAST scores?

Patients with high-risk FAST scores (>0.35) were younger, had higher BMIs, elevated liver enzyme levels, and poorer glycemic control compared with lower-risk groups.

Sep 30, 2026

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